Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study.

Autor: Gertner AK; School of Medicine, Chapel Hill, University of North Carolina at Chapel Hill, North Carolina.; Corresponding author: Alex K. Gertner, MD, PhD, 321 S Columbia St, Chapel Hill, NC 27516 (alex.gertner@unchealth.unc.edu)., Grove LR; Dell Medical School, University of Texas at Austin, Austin, Texas., Swietek KE; NORC at the University of Chicago, Boston, Massachusetts., Lin CC; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan., Ray N; Center for Medication Optimization, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Malone TL; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Rosen DL; Institute for Global Health and Infectious Diseases, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Zarzar TR; Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Domino ME; Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona., Steiner BD; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jazyk: angličtina
Zdroj: The Journal of clinical psychiatry [J Clin Psychiatry] 2023 Apr 05; Vol. 84 (3). Date of Electronic Publication: 2023 Apr 05.
DOI: 10.4088/JCP.22m14496
Abstrakt: Objective: People with serious mental illness (SMI) have high rates of cardiometabolic illness, receive low quality care, and experience poor outcomes. Nevertheless, studies of existing integrated care models have not consistently shown improvements in cardiometabolic health for people with SMI. This study assessed the effect of a novel model of enhanced primary care for people with SMI on cardiometabolic outcomes. Enhanced primary care is a model of integrated care wherein comprehensive primary care delivery is adapted to the needs of people with SMI in coordination with behavioral care.
Methods: We conducted a propensity-weighted cohort study comparing 234 patients with SMI receiving enhanced primary care to 4,934 patients with SMI receiving usual primary care using electronic health data from a large academic medical system covering the years 2014-2018. The propensity-weighted models controlled for baseline differences in outcome measures and patient characteristics between groups.
Results: Compared to usual primary care, enhanced primary care increased hemoglobin A 1c (HbA 1c ) screening by 18 percentage points (95% confidence interval [CI], 10 to 25), low-density lipoprotein (LDL) screening by 16 percentage points (CI, 8.8 to 24), and blood pressure screening by 7.8 percentage points (CI, 5.8 to 9.9). Enhanced primary care reduced HbA 1c by 0.27 percentage points (CI, -0.47 to -0.060) and systolic blood pressure by 3.9 mm Hg (CI, -5.2 to -2.5) compared to usual primary care. We did not find evidence that enhanced primary care consistently affected glucose screening, LDL values, or diastolic blood pressure.
Conclusions: Enhanced primary care can achieve clinically meaningful improvements in cardiometabolic health compared to usual primary care.
(© Copyright 2023 Physicians Postgraduate Press, Inc.)
Databáze: MEDLINE
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